Scientists in Bangladesh are working on ways to treat toilet waste in rural areas and use it to develop safe, nutritious compost for food crops. Led by the school of civil engineering at Leeds University, the Value at the End of the Sanitation Value-Chain (VESV) project aims to help reduce reliance on imported inorganic fertilisers and provide potential business opportunities for waste transporters and compost producers in a country where access to sanitation is now widespread but challenges of managing waste remain.

Farmers tend their cabbage crops in Manikganj district. Bangladesh has benefited from major improvements in rural sanitation with the spread of pit toilets – holes dug in the ground.

These bypass the problem of installing sewerage infrastructure in densely populated rural areas, but the challenge is what to do with the waste when the pits are full. If treated carefully, this waste could provide a local source of organic matter and plant nutrients such as nitrogen, potassium and phosphorus. All photographs by Neil Palmer/IWMI.

To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh. Case households were more likely than controls to have crowded (≥4 persons) sleeping areas and cross-ventilated cooking spaces. Case and control households had similar median 24-hour geometric mean PM2.5 concentrations in the cooking and sleeping spaces. Handwashing with soap was practiced infrequently, and was not associated with pediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.

Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework. (Full text)
WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes.

LANCET INFECTIOUS DISEASES – FEB 2015

Editorial – Prioritising clean water and sanitation (Free full text but registration required)
Sanitation is the single greatest human achievement with regard to health, yet in much of the world it is underappreciated or inaccessible. Talha Burki investigates. “Currently, the popular approaches to sanitation place a lot of responsibility on individuals and households and not as much on governments”, adds WaterAid’s Yael Velleman. In the UK, it was legislation that led to universal access to improved sanitation. “Ultimately, it was political will and public finance that pushed that drive—I wonder whether we now expect low-income countries to do something we have never done ourselves”, said Velleman. Pollock advocates a return to a health-for-all approach, attending to the building blocks of public health, such as sanitation and nutrition, and directing major investment into infrastructure and monitoring systems. “I can’t understand why we’re prioritising clinical trials in Africa, and not prioritising clean water”, she told The Lancet Infectious Diseases.

Inadequate water, sanitation and hygiene (WASH) represent an important health burden in the Philippines. The non-governmental organisation Fit for School intends to complement its handwashing programme in schools with sanitation interventions. The objectives of this mixed-method study therefore were to describe WASH practices and their impact on childhood diarrhoea in the Philippines, and to examine socio-cultural and environmental factors underlying defecation and anal cleansing practices in Northern Mindanao. When adjusting for non-modifiable factors, susceptibility and socioeconomic factors, WASH factors failed to show a statistically significant effect. Defecation and anal cleansing behaviours were constrained by the physical environment, particularly the lack of clean, safe, comfortable and private facilities. Individual determinants of behaviour were influenced by habit and motivations such as disgust, with some evidence of planned behaviour. Where available, water was the preferred material for anal cleansing. This study combines nationally-representative quantitative data with local in-depth qualitative insights, constituting critical formative research in the development of effective and appropriate interventions.

Many clinics in rural western Kenya lack access to safe water and hand-washing facilities. To address this problem, in 2005 a programme was initiated to install water stations for hand washing and drinking water in 109 health facilities, train health workers on water treatment and hygiene, and motivate clients to adopt these practices. In 2008, we evaluated this intervention’s impact by conducting observations at facilities, and interviewing staff and clients about water treatment and hygiene. Of 30 randomly selected facilities, 97% had water stations in use. Chlorine residuals were detectable in at least one container at 59% of facilities. Of 164 interviewed staff, 79% knew the recommended water-treatment procedure. Of 298 clients, 45% had received training on water treatment at a facility; of these, 68% knew the recommended water-treatment procedure. Use of water stations, water treatment, and client training were sustained in some facilities for up to 3 years.

The prevalence of stunting ranged from 25% to 50% across the three studies. Compared with open defecation, household access to toilet facility was associated with a 16–39% reduced odds of stunting among children aged 0–23 months, after adjusting for all potential confounders. Household access to improved water supply or piped water was not in itself associated with stunting. The caregiver’s self-reported practices of washing hands with soap before meals or after defecation were inversely associated with child stunting. However, the inverse association between reported personal hygiene practices and stunting was stronger among households with access to toilet facility or piped water. Improved conditions of sanitation and hygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming aiming to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomised trials are warranted to validate the causal association.

JNL WATER HEALTH – MAR 2015

Assessment of a membrane drinking water filter in an emergency setting – (Abstract/order info)
The performance and acceptability of the NeroxTM membrane drinking water filter was evaluated among an internally displaced population in Pakistan. The membrane filter and a control ceramic candle filter were distributed to over 3,000 households. Following a 6 month period, 230 households were visited and filter performance and use was assessed. Only 6% of the visited households still had a functioning filter, and the removal performance ranged from 80 to 93%. High turbidity in source water (irrigation canals) together with high temperatures, and large family size were likely to have contributed to poor performance and uptake of the filters.

If you would like to be on the mailing list for these periodic research updates, just email me at: dacampbell@fhi360.org

Sustainability is without doubt one of the most burning subject matters that subsumes many of the issues that we are seeing in CLTS and wider WASH practice.

There have been several useful studies on sustainability that have highlighted some of the different aspects as well as the complexities involved. However, it is unclear how much of the learning from these studies has been built into current and future programming and practice.

Based on existing research and our own understanding, this issue of Frontiers of CLTS is an attempt at an up to date synthesis of where we are at the beginning of 2015.

In the issue, we identify some priority areas for learning: How to phase in sanitation marketing; Post-ODF engagement of government, NGOS, donors and others; How to ensure equity and inclusion; How to transform social norms; Monitoring, learning, changing.

This weekly contains recent webinars, articles, and reports on issues related to WASH and nutrition integration. Included are a policy brief on food hygiene, a handwashing and sanitation study in Tanzania, an overview of the nutrition situation in Asia, a review of the health impact of household water treatment, and other resources.

UPCOMING EVENTS

Global Maternal Newborn Health Conference, Oct. 18–21, 2015, Mexico City. Link
The year 2015 is a critical milestone in international development: the deadline for the Millennium Development Goals (MDGs) and the anticipated adoption of an ambitious new agenda, the Sustainable Development Goals. This USAID– and Government of Mexico–sponsored conference will offer the first opportunity for the global maternal and newborn health communities to discuss and strategize the new goals. The conference will have a technical focus, highlighting strategies and lessons from programs, policies, research, and advocacy for improving both maternal and newborn health.

WEBINARS/BLOG POSTS/TRAINING MATERIALS

Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes: A Training and Resource Pack for Uganda, 2014. WASHplus. Link
The overall objective of this resource pack is to facilitate the training of village health teams, community knowledge workers, peer support groups, and other outreach workers on how they can help household and community members overcome, or change, the many daily obstacles to improved water, sanitation, and hygiene (WASH) practices in the home.

Webinar on Multi-Sectoral Approaches to Improve Child Growth through WASH, Nutrition, and Early Childhood Development, Jan 2015. WASHplus; CORE Group; Clean, Fed & Nurtured. Link
WASHplus collaborated with the CORE Group’s Nutrition and Social and Behavior Change working groups to host a one-hour webinar on multisectoral approaches to improve child growth and development, with a focus on improving the community knowledge of practice and sharing integration efforts for early childhood development, nutrition, and WASH integration. The Clean, Fed & Nurtured community of practice explained why WASH, nutrition, and early childhood development should be integrated.

Progress in Reducing Child Under-Nutrition: Evidence from Maharashtra. Economic & Political Weekly, Jan 2015. S Jose. Link
Assessing the progress made in reducing under-nutrition among children who are less than 2 years old in Maharashtra between 2005–2006 and 2012, this article points out that child under-nutrition, especially stunting, declined significantly in the state during this period. It holds that this decline can be associated with the interventions initiated through the Rajmata Jijau Mother-Child Health and Nutrition Mission, which began in 2005, and that this indicates the critical role the state can play in reducing child under-nutrition in India.

WASH and Nutrition Case Studies, 2014. WASHplus. Link
These 12 case studies were collected as part of putting together a joint donor document on Integrating Water, Sanitation, and Hygiene into Nutrition Policies and Programmes, which will soon be published by UNICEF, USAID, and the World Health Organization. In selecting these case studies, priority was given to activities that achieved measurable nutrition-related impact.

Benefits and Costs of the Water Sanitation and Hygiene Targets for the Post-2015 Development Agenda: Assessment Paper, 2015. G Hutton, The World Bank. Link
Within the area of water and sanitation the targets with the highest benefit-cost ratio are: basic water and basic sanitation in rural areas and eliminating open defecation in rural areas. Other valuable targets in this focus area include: basic sanitation and basic water in urban areas.

Post-2015 Consensus: Water and Sanitation Perspective, 2015. D Whittington. Link
The author reviews the Guy Hutton assessment paper (above) and argues for a carefully done cost-benefit analysis to show that many WASH interventions are economically attractive investments.

Greater Investment in Water, Sanitation and Hygiene is Key to the Fight Against Undernutrition, 2015. C Denis, Action Contre La Faim. Link
The report concludes that the WASH sector must be funded at levels that reflect its impact on under-nutrition and that strategies and programs for fighting under-nutrition must incorporate a long-term multisector component that includes WASH targets and indicators.

Water, Sanitation and Hygiene: Determining a Health Goal that Works for All, 2015. WaterAid. Link
Access to basic drinking water, sanitation, and hygiene is vital to improving health and quality of life globally. As discussions on the post-2015 framework and the Sustainable Development Goals reach their crucial final phase, WaterAid is calling for WASH to be recognized as a key influential factor to be closely integrated into any health goal and priorities taken up by governments and civil society.

Promoting Handwashing and Sanitation Evidence from a Large-Scale Randomized Trial in Rural Tanzania, 2015. B Briceño, The World Bank. Link
This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. For the campaign, 181 wards were randomly assigned to receive sanitation promotion, handwashing promotion, both interventions together, or neither. One year after the end of the program, sanitation wards increased latrine construction rates from 38.6 to 51 percent and reduced regular open defecation from 23.1 to 11.1 percent. Households in handwashing wards showed marginal improvements in handwashing behavior related to food preparation, but not at other critical junctures.

Culture and the Health Transition: Understanding Sanitation Behavior in Rural North India, 2015. D Coffey. Link
This paper draws on new qualitative and quantitative data to examine the cultural meanings of latrine use and open defecation. It finds that beliefs, values, and norms about purity and pollution of private spaces and of bodies help explain widespread open defecation, and that renegotiation of caste and untouchability complicates the adoption of simple latrine technologies.

Policy Memo on Toilet Technology & Culture, 2015. RICE Institute. Link
This notes asks why rural India has uniquely high rates of open defecation. It first explains that the “usual suspects”—GDP, poverty, education, water access—are not to blame for widespread open defecation in rural India. Second, it discusses how the sanitation technology used in rural India differs from the rest of the developing world—in short, very few rural Indian households use latrines with inexpensive underground soak pits. Third, it presents qualitative and quantitative evidence that Hindu practices of purity and pollution, as well as India’s unique history and renegotiation of untouchability, complicate the adoption of the kinds of simple, inexpensive latrines that have been used to reduce open defecation in other developing countries.

Nutritional Status of Women and Children: A 2014 Update on Nutritional Status by Sociodemographic and Water, Sanitation, and Hygiene (WASH) Indicators Collected in Demographic and Health Surveys, 2014. M Kothari, PATH. Link
To provide current context, this report looks at stunting in the framework of common WASH indicators. This report provides a descriptive analysis of the status of women and children in the context of nutrition, breastfeeding, complementary feeding, anemia, dietary diversity, and micronutrient supplementation. The report also provides information on the nutritional status of women and children, with data disaggregated by selected WASH indicators.

Large Decrease in Child Stunting in Bangladesh Despite Limited Improvement in Children’s Food Intake, 2014. M Jain, HarvestPlus, International Food Policy Research Institute. Link
Bangladesh recorded one of the fastest reductions in child stunting between 1997 and 2007. The author does a descriptive decomposition analysis of this rapid decrease, focusing on the role of nutrient intake relative to other important child health inputs, such as maternal health, sanitation, maternal education, and access to health services. Among other factors, maternal health and access to sanitation were found to be the largest drivers of the growth of children across time. Maternal education and access to health services also have a positive, but non-robust, association with growth.

Overview of the Nutrition Situation in 11 Countries in Asia, 2015. FANTA III. Link
FANTA conducted a critical review of the nutrition situation in 11 countries in Asia, which is presented by region (South-Central Asia and Southeast Asia) and by country. The two nutrition overview reports and 11 country profiles provide an in-depth analysis of the key drivers of malnutrition;,current statistical nutrition data and trends for each country, and recommendations for areas to invest in to improve nutrition.

Professor Cairncross at the STOP Stunting Conference, 2014. SHARE. Video
In this video Sandy Cairncross, SHARE research director, shares his thoughts on why reducing stunting is such a priority for South Asia. Professor Cairncross attended the STOP Stunting Conference in New Delhi (November 2014) to deliver a presentation on the links between sanitation and stunting.

JOURNAL ARTICLES/VIDEOS

Household Water Treatment and Safe Storage to Prevent Diarrheal Disease in Developing Countries. Current Environmental Health Reports, Jan 2015. T Clasen. Link
Household water treatment and safe storage, such as boiling, filtering, or chlorinating water at home, have been shown to be effective in improving the microbiological quality of drinking water. However, estimates of their protective effect against diarrhea, a major killer, have varied widely. While results may be exaggerated because of reporting bias, this heterogeneity is consistent with other environmental interventions that are implemented with varying levels of coverage and uptake in settings where the source of exposure represents one of many transmission pathways.

Risk Factors Associated with Recurrent Diarrheal Illnesses among Children in Kabul, Afghanistan: A Prospective Cohort Study. PLoS One, Feb 2015. A Aluisio. Link
Maternal handwashing and improved sanitation facilities were protective, and represent important prevention points among public health endeavors. The discrepancy between soap availability and use suggests barriers to access and knowledge, and programs simultaneously addressing these aspects would likely be beneficial. Enhanced maternal education and economic status were protective in this population, and these findings support multisector interventions to combat illness.

Age-Related Factors Influencing the Occurrence of Undernutrition in Northeastern Ethiopia. BMC Public Health, Feb 2015. A Degarege. Link
The objective of the current study was to assess the prevalence of under-nutrition in different age groups and examine the relationship of the disease to parasitic and socioeconomic factors among communities in Harbu Town, northeastern Ethiopia. The odds of under-nutrition significantly decreased with an increase in the age of individuals. The odds of under-nutrition in the 5 to 19 years age group was significantly higher in those who did not wash their hands before eating than in those who did. The prevalence of under-nutrition in children younger than 5 years was significantly lower in those whose families were educated and had a family size less than five compared to those with illiterate families and a family size greater than five.

Assessing Factors that Lead to Use of Appropriate Technology: Handwashing Stations in Mali, West Africa. Journal of Water, Sanitation and Hygiene for Development, In Press 2015. C Naughton. Abstract/Order info
This study presents results of a mixed methods approach and comprehensive monitoring strategy of five use variables (use of soap, handwashing station functionality, presence of cleansing agent including soap or white ash, ground wetness, and amount of water in the jug) over two years for 42–64 appropriate technology handwashing stations located in two communities in Mali. Six factors were studied as potentially critical for lasting use of handwashing stations (gender, educational training, water proximity, seasonality, wealth, and station adoption). Statistically significant results include: a 29 percent decrease in use of soap between the dry and rainy seasons; a 35 percent decrease in stations with cleansing agent (e.g., soap or white ash) present over one year; greater station use in wealthy households; and greater use of stations built by women in one community.

The WASH Approach: Fighting Waterborne Diseases in Emergency Situations.Environmental Health Perspectives, Jan 2015. W Nicole. Link
Poor hygiene and fecal contamination were major factors in one of the world’s biggest outbreaks of hepatitis E, which began in October 2007 and persisted for a couple of years. This outbreak affected camps for internally displaced persons (IDPs) in northern Uganda’s Kitgum District, infecting more than 10,000 people and killing 160, mostly pregnant women and young children. Other recent hepatitis E outbreaks have occurred among refugees and IDPs in Kenya, South Sudan, and Chad.

The Other Asian Enigma: Explaining the Rapid Reduction of Undernutrition in Bangladesh.World Development, Feb 2015. D Headey. Link
Although South Asia has long been synonymous with persistent and unusually high rates of child under-nutrition—the so called Asian Enigma—Bangladesh has managed to sustain a surprisingly rapid reduction in the rate of child under-nutrition for at least two decades. This unheralded success is investigated through a regression and decomposition analysis of changes in child growth outcomes across five rounds of Demographic and Health Surveys from 1997 to 2011. Among the findings: rapid wealth accumulation and large gains in parental education are the two largest drivers of change, though health, sanitation, and demographic factors have played significant secondary roles.

Hand-to-Mouth Contacts Result in Greater Ingestion of Feces than Dietary Water Consumption in Tanzania: A Quantitative Fecal Exposure Assessment Model.Environmental Science & Technology, Jan 2015. M Mattioli. Link
Contaminated drinking water and hands are two important environmental transmission routes of diarrhea-causing pathogens to young children in low-income countries. The objective of this research is to evaluate the relative contribution of these two major exposure pathways in a low-income country setting. The model outcome is a distribution of a child’s daily dose of feces via each exposure route. The model results show that Tanzanian children ingest a significantly greater amount of feces each day from hand-to-mouth contacts than from drinking water, which may help elucidate why interventions focused on water without also addressing hygiene often see little to no effect on reported incidence of diarrhea.

Reducing Child Undernutrition: Past Drivers and Priorities for the Post-MDG Era.World Development, Apr 2015. L Smith. Link
As the post-MDG era approaches in 2016, reducing child under-nutrition is gaining high priority on the international development agenda, both as a maker and marker of development. Revisiting Smith and Haddad (2000), this article uses data from 1970 to 2012 for 116 countries, finding that safe water access, sanitation, women’s education, gender equality, and the quantity and quality of food available in countries have been key drivers of past reductions in stunting. Income growth and governance played essential facilitating roles. Complementary to nutrition-specific and nutrition-sensitive programs and policies, accelerating reductions in under-nutrition in the future will require increased investment in these priority areas.

Seasonal Variation of Fecal Contamination in Drinking Water Sources in Developing Countries: A Systematic Review. Science of the Total Environment, May 2015. C Kostylaa.Abstract/order info
Accounting for fecal contamination of drinking water sources is an important step in improving monitoring of global access to safe drinking water. Fecal contamination varies with time while its monitoring is often infrequent. This study sought to understand seasonal trends in fecal contamination to guide best practices to capture seasonal variation and ascertain the extent to which the results of a single sample may overestimate compliance with health guidelines. The findings from 22 studies from developing countries were analyzed. Fecal contamination in improved drinking water sources was shown to follow a statistically significant seasonal trend of greater contamination during the wet season. This trend was consistent across fecal indicator bacteria, five source types, and across both rural and urban areas. Guidance on seasonally representative water quality monitoring by the World Health Organization and national water quality agencies could lead to improved assessments of access to safe drinking water.
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WASHplus Weeklies highlight topics such as Urban WASH, Household Air Pollution, Innovation, Household Water Treatment and Storage, Hand Washing, Integration, and more. If you would like to feature your organization’s materials in upcoming issues, please send them to Dan Campbell, WASHplus Knowledge Resources Specialist, at dacampbell@fhi360.org.

Can microfinance help increase access to sanitation? Today, 2.5 billion people do not use proper sanitation facilities. Essential services for maintaining latrines and treating faecal sludge are also underdeveloped. In many places, toilets can cost up to one year of income for poor households. Private operators of sanitation services do not have enough capital to acquire more equipment and respond to growing demand.

Since 2010, Trémolet Consulting and research partners based in Kenya MicroSave have been exploring the potential of microfinance for helping sanitation markets to develop. The research, funded by SHARE/DFID, culminated with an action-research in Tanzania in which financial institutions were trained to provide financial services for sanitation. This film explains why microfinance should be explored further, and potentially, included in sanitation programmes.

The film also presents what has been done in Tanzania under the action-research and takes the views of households, sanitation entrepreneurs, microfinance institutions and researchers.

Sustainable Sanitation Alliance is holding a 3-week thematic discussion on the topic: the sanitation ladder

“The Sanitation Ladder: Next Steps” thematic discussion is the first discussion in the newly launched Thematic Discussion Series from the Sustainable Sanitation Alliance (SuSanA)!

This first thematic discussion is taking place from February 9-27 2015 on the SuSanA Discussion Forum. Up-to-date bi-weekly summaries of the discussions will be posted. On Thursday, February 20th, a webinar will be led by the thematic leads to discuss the key issues from the discussion. The exact time of the webinar will be posted next week.

The discussion focuses on the development of the sanitation ladder, the post-2015 agenda and monitoring challenges, and the way forward. Three thematic experts are providing leadership throughout the discussions: Patrick Bracken, a Water and Sanitation Specialist from AHT Group AG, Elisabeth Kvarnström, a senior consultant with Urban Water Management, Inc., and Ricard Gine, WASH researcher from the Universitat Polècnica de Catalunya.

Here, Copenhagen Consensus Center has just released its latest research on water and sanitation targets for the post-2015 development agenda. Guy Hutton, Senior Economist, at the Water and Sanitation Program (WSP), World Bank writes the main report, with research assistance provided by Mili Varughese, Operations Analyst at WSP.

Guy Hutton, Senior Economist for the World Bank’s Water and Sanitation Program, writes a paper examining the costs and benefits of ending open defecation and providing universal access to water and sanitation. He finds that in general, it is more cost-beneficial to serve rural populations since they save more time from having improved access to water and sanitation facilities. Additionally, it is more effective to provide for the poorest, because they start with poorer health and have greater capacity to improve from access. Regardless of location and income, providing water and sanitation passes a cost-benefit test.

Dale Whittington, Professor, Departments of Environmental Sciences & Engineering at University of North Carolina, makes a critical examination of the assessment paper, noting several challenges with the benefit-cost calculations. In particular, he outlines concerns with how time savings are calculated, the likelihood of 100% take up of the interventions, assumptions around the cost base and how sensitivity analysis is applied in the paper. Despite these issues, Whittington agrees that water and sanitation interventions are likely to be cost-beneficial, though very sensitive to local conditions.

Dale Whittington also writes a stand-alone paper on water resources management targets. In a thought-provoking discussion he argues that global average benefit-cost ratios for water resource management investments are not useful because investments must be analyzed at the local level. Secondly, he suggests that it would be wrong for low-income countries to prioritize health interventions over large scale water infrastructure, since the latter are a necessary pre-requisite for the former.

Mary Ostrowski and Allan Jones of the World Chlorine Council present their views on the ‘safely managed drinking water service’ aspect of the proposed WASH targets. They argue that the most effective way to check drinking water quality is testing for the chlorine residual to ensures that the water is safe and free from disease causing germs.​

Guest editorial: tackling the stigma and gender marginalization related to menstruation via WASH in schools programmes(abstract/order info)
Menstrual hygiene management has been defined as: ‘Women and adolescent girls using a clean menstrual management material to absorb or collect blood that can be changed in privacy as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required, and having access to facilities to dispose of used menstrual management materials’ (UNICEF and WHO, 2014). However, menstrual hygiene is not just about the management of the menstrual period but also the need to address societal beliefs and taboos surrounding the issue.

Until recently, the development sector including WASH (water, sanitation and hygiene) had not explored and attempted to address the challenges related to Menstrual Hygiene Management (MHM), an important issue affecting the health, dignity and privacy of millions of girls and women on a daily basis. It is great to have a whole issue of Waterlines dedicated to MHM, as it will help us, the maledominated, engineering-based sector, to increase our understanding of this aspect of the development work we do on a daily basis.

Mainstreaming menstrual hygiene management in schools through the play-based approach: lessons learned from Ghana(full text)
The study objective was to identify and document the effectiveness of the play-based approach in promoting menstrual hygiene management (MHM) in schools and share lessons learned. The study used a mix of approaches including qualitative and quantitative techniques. The author carried out an exploratory evaluation on the promotion of MHM activities as part of WASH in Schools programmes in 120 public schools in Ghana. Comparison was drawn between 60 schools currently using the play-based approach in promoting MHM, and 60 schools which are not using the play-based approach.

Developing games as a qualitative method for researching menstrual hygiene management in rural Bolivia(abstract/order info)
In 2012, Emory University and UNICEF conducted a multi-country formative study to gain a global perspective of girls’ experiences. A compendium of tools was created to ensure investigation of common themes across all settings. This paper describes the process of adapting the focus group discussion (FGD) tool for Bolivia into a board game as a method to ease girls’ discomfort discussing menstruation and elicit richer data.

WaterSHED has published the findings from its comprehensive review of rural consumer sanitation adoption in Cambodia. The study evaluates WaterSHED’s Hands-Off sanitation marketing program, which was designed to catalyze the market for improved sanitation in rural Cambodia by stimulating household demand and improving the supply of affordable sanitation options for rural households.

The study confirms that the WaterSHED program has resulted in a substantial acceleration in improved latrine coverage and usage in the study areas. Household consumers are now able to access an improved latrine more easily and more cheaply than before.

New distribution and sales mechanisms are increasing household awareness of and exposure to more affordable latrine products and increasing motivation to invest in an improved latrine.

Enterprises are demonstrating that they serve at least some segments of the previously unserved rural market.

Nonetheless, significant challenges still remain. The study reveals a number of opportunities to break down remaining barriers to uptake of improved latrines and to further evolve WaterSHED’s market-based approach.

When we go to the supermarket, our decision-making is considerably aided by having the price, ingredients and source of goods clearly labeled. This allows us to rapidly compare the characteristics, perceived benefits, and price of different products to make what is usually an informed and instantaneous purchase decision.

When it comes to making investment choices for public programs, we do not traditionally have the same luxury of information. The full benefits and costs of those interventions, including the long-term costs to maintain and operate a service, are rarely understood or taken into account in the decision. As a result, public decisions are usually made based on the most visible costs (capital investment required from the public budget), historical choices and the political process.

To reduce the detrimental effects of these influences, we need to move public sector decision making more towards the supermarket model, and increase the availability of key information so that decisions can be more rational, consistent, and transparent.

Since 2007, the Water and Sanitation Program (WSP), part of the World Bank’s Water Global Practice, has been attempting to put a price on sanitation by essentially understanding two sides of the same coin: what the costs of current inaction on sanitation are (i.e. how much poor sanitation costs households and the wider economy) and how much acting will cost (i.e. increasing access to sanitation services).

When it comes to acting, we need to understand the alternatives. What technology option best suits the preferences and local practices, available land, population density, disposable income, and willingness to pay of different population groups? What are the benefits of different technology options? And who is able to pay for the costs of behavior change, capital investment and sustained service delivery?

Excerpts: The present study has presented evidence on the costs and benefits of sanitation improvements in different programmatic and geographical contexts in Southeast Asia. This evidence enables explicit comparison of sanitation options on the basis of their relative merits and thus informs both public and private decisions on sanitation investment.

The high socioeconomic returns of sanitation investment indicate that it should be promoted as a central development priority. The economic evidence generated in this study has demonstrated the importance of improved sanitation for a number of development outcomes, including public health, the natural environment, education, economic development, social outcomes, gender equality, and poverty alleviation. Improved evidence on the costs of sanitation and those potentially willing to pay for it, gives an evidence base for sanitation planners and providers on which to estimate the market size for sanitation goods and services.

The association between hygiene, sanitation, and health is well documented, yet thousands of children die each year from exposure to contaminated fecal matter. At the same time, evidence on the effectiveness of at-scale behavior change interventions to improve sanitation and hygiene practices is limited.

This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. For the campaign, 181 wards were randomly assigned to receive sanitation promotion, handwashing promotion, both interventions together, or neither. One year after the end of the program, sanitation wards increased latrine construction rates from 38.6 to 51 percent and reduced regular open defecation from 23.1 to 11.1 percent.

Households in handwashing wards show marginal improvements in handwashing behavior related to food preparation, but not at other critical junctures. Limited interaction is observed between handwashing and sanitation on intermediate outcomes: wards that received both handwashing and sanitation promotion are less likely to have feces visible around their latrine and more likely to have a handwashing station close to their latrine facility relative to individual treatment groups.

Final health effects on child health measured through diarrhea, anemia, stunting, and wasting are absent in the single-intervention groups. The combined-treatment group produces statistically detectable, but biologically insignificant
and inconsistent, health impacts. The results highlight the importance of focusing on intermediate outcomes of take-up and behavior change as a critical first step in large-scale programs before realizing the changes in health that sanitation and hygiene interventions aim to deliver.

This issue highlights the recent conference on fecal sludge management in Vietnam; many of the abstracts from the conference are now available. Also included are new reports and articles from IRC; Water For People; the International Institute for Environment and Development; and country reports from Senegal, Vietnam, and Zambia. Also included are links to FSM tools and innovative organizations working on FSM issues.

Achieving Systemic Change in Faecal Sludge Management, 2015. G Galli, IRC. Link
FSM is a critical element of sanitation in dense urban centers, but poor practices are causing disease outbreaks. The multiple actors, institutions, and organizations involved in urban sanitation can address the problem by acting in coordination to shift the focus from building infrastructure to providing and maintaining safe services under government leadership. This briefing note proposes a process for achieving transformational change.

Strengthening Public Sector Enabling Environments to Support Sanitation Enterprises, 2014. Water For People. Link
Water For People is piloting sanitation business approaches and seeks to discover under what conditions these approaches are successful. Public sector influence is one condition that has the potential to facilitate or hinder private sector sanitation endeavors. This study aims to understand: 1) how the public sector enabling environment can facilitate or hinder low-cost sanitation enterprises and 2) how NGOs can effectively engage the public sector to support sanitation businesses. Data were collected from Water For People staff and partners in nine countries, and summary case studies were coded to identify prevailing themes.

Triggering Increased City-Level Public Finance for Pro-Poor Sanitation Improvements: The Role of Political Economy and Fiscal Instruments, 2014. J Boex.Link
The goal of this background paper is to provide a general framework for understanding the political economy and fiscal determinants of sanitation service provision by urban local governments. The paper will review existing literature to begin answering several questions: what do we expect to influence spending on local sanitation? Do different fiscal instruments have an impact on expenditure levels? Do increased local revenues lead to increased expenditures over the long term? What role do different stakeholders play in determining expenditure levels?

Realizing the Right to Sanitation in Deprived Urban Communities: Meeting the Challenges of Collective Action, Coproduction, Affordability, and Housing Tenure.World Development, Apr 2015. G McGranahan. Link
Serious institutional challenges are associated with low-cost sanitation in deprived urban communities. These include a collective action challenge, a coproduction challenge, a challenge of affordability versus acceptability, and a challenge related to housing tenure. This paper examines these challenges, revealing both the importance of community-driven sanitation improvement and its difficulties.

Faecal Sludge to Fuel: Revenue to Improve Sanitation Services. Eawag News, July 2014. M Gold. Link
Cities in sub-Saharan Africa grapple with the management of fecal sludge from onsite sanitation technologies. A lack of funding for sanitation services results in the dumping of fecal sludge directly in the urban environment. Revenues generated from using dried fecal sludge as a combustible fuel in industries could provide an incentive to improve fecal sludge collection, transport, and treatment services.

Faecal Sludge Management (FSM) Book: Systems Approach for Implementation and Operation, 2014. L Strande. Link
This is the first book dedicated to fecal sludge management. It compiles the current state of knowledge of this rapidly evolving field and presents an integrated approach that includes technology, management, and planning. It addresses the planning and organization of the entire fecal sludge management service chain, from the collection and transport of sludge and treatment options, to the final end use or disposal of treated sludge.

Finding Short- and Long-Term Solutions to the Developing World’s Sanitation Crisis. NPR, Jan 2015. B Hardzin. Link
Jan-Willem Rosenboom is a senior program officer for Water, Sanitation and Hygiene at the Bill and Melinda Gates Foundation. He says the organization realized it was effective at community-level work but did not have a good way to deliver services on a large scale. He also argues that throwing money at the world’s water and sanitation system won’t solve the problem.

FSM TOOLS

SANIPATH Rapid Assessment Tool – Website
The SaniPath Rapid Assessment Tool aims to assess exposure to fecal contamination in urban, low-income settings. The tool is under development by the Center for Global Safe Water at Emory University with funding from the Bill & Melinda Gates Foundation. The tool guides users in collecting much needed data on exposure to fecal contamination in low income, urban neighborhoods, and synthesizes these data for community, government, and service providers’ decision-making.

Sanitation Service Chain and Service Delivery Assessment Scorecard – Link
This Water and Sanitation Research Brief describes the Sanitation Service Chain which sets out the interlinked steps required to deliver urban sanitation and the Service Delivery Assessment Scorecard which analyzes the enabling environment, the level and management of budgets and other inputs needed to develop adequate fecal sludge management services, and the factors contributing to service sustainability.

Diagnostics and Guidelines for Fecal Sludge Management in Poor Urban Areas – Link
A presentation by Isabell Blackett at the 3rd International Faecal Sludge Management Conference.

Urban Sanitation Status Index: A Tool for Prioritizing Interventions – Link
Page 30 has an abstract of a presentation on the Urban Sanitation Status Index (USSI) which was developed to assess sanitation status at a neighborhood level. The USSI acts as a strategic tool for sanitation managers and decision makers in Maputo.

VIDEOS

Innovation in Urban Sanitation: FaME and U-ACT Research in Sub-Saharan Africa, 2015. Eawag. Video
In sub-Saharan Africa sanitation needs of the majority of the urban population are met by onsite sanitation technologies. These technologies can provide sustainable and more affordable sanitation compared to sewer-based systems. The FaME (Faecal Management Enterprises) andU-ACT projects researched innovative solutions to increase access to sustainable sanitation services.

Uganda: Health Risk Assessment along the Wastewater and Faecal Sludge Management Chain of Kampala, 2015. S Furimann. Video
This video is an assessment of health risks along the major wastewater channel in Kampala, Uganda. The visualization brings to bear the context of wastewater reuse activities in the Nakivubo wetlands and emphasizes interconnections to disease transmission pathways.

SuSanA Playlist – This playlist contains all filmed presentations of the Second International Faecal Sludge Management Conference in Durban, South Africa, October 2012 (46 total). Link

COUNTRY REPORTS

Senegal: Report of the Situational Analysis of Fecal Sludge Management Sector in Tambacounda, Executive Summary, 2014. USAID. Link
In Senegal, the improvement of the lives of people through efficient and appropriate sanitation is a priority for the government and its development partners. However, political and strategic directions of the government have long advocated “all for the sewer” to the detriment of individual draining systems, even though about 75 percent of the population uses individual draining systems. The National Sanitation Office of Senegal continues to make significant efforts to help improve the offerings of fecal sludge management services.

Vietnam: Rural Sanitation Rapid Market Scan Report, 2014. Population Services International (PSI). Link
Leveraging PSI Vietnam’s understanding of rural markets and consumers, the rapid sanitation market scan was designed to identify practical insights from rural households and community influencers, as well as rural supply chain actors linked to sanitation product and service provision. This report describes the market scan findings and offers concrete recommendations to inform future programs.

Zambia: FSM Services in Lusaka – Moving Up the Excreta Management Ladder, 2014. Water and Sanitation for the Urban Poor. Link
Despite most residents of African and Asian cities depending on non-sewered sanitation, only a handful of sanitation authorities have addressed the management of fecal sludge from these systems. This Practice Note describes the launch of an FSM service in the peri-urban area of Kanyama, Zambia.

A Bangladesh government official has disclosed that the 6th South Asian Conference on Sanitation (SACOSAN-VI) will be held in Dhaka on 11 January 2016. Bangladesh hosted the first edition of SACOSAN in 2003.

Manjur Hossain, a senior secretary of the Local Government Division (LGD) of the Ministry of Local Government, Rural Development and Cooperatives was speaking at the 7th inter-country working group (ICWG) meeting of SACOSAN. The meeting was hosted by LGD from 27-28 January 2015 in Dhaka.

Also at the meeting was Md Akram Al Hossain, coordinator of the SACOSAN-VI secretariat and Joint Secretary, Upazila Branch at LGD.

Filed under: Campaigns and Events, Progress on Sanitation, South Asia Tagged: Bangladesh, SACOSAN, SACOSAN VI]]>https://sanitationupdates.wordpress.com/2015/01/28/sacosan-returns-to-bangladesh-in-2016/feed/0dietvorst7th inter-country working group (ICWG) meeting of SACOSAN, 27 Jan 2015.Mar 2015 Eawag course on Systematic Behaviour Change in Development Projectshttps://sanitationupdates.wordpress.com/2015/01/22/mar-2015-eawag-course-on-systematic-behaviour-change-in-development-projects/
https://sanitationupdates.wordpress.com/2015/01/22/mar-2015-eawag-course-on-systematic-behaviour-change-in-development-projects/#commentsThu, 22 Jan 2015 16:19:32 +0000http://sanitationupdates.wordpress.com/?p=10825Continue reading →]]>We would like to announce our next practice-oriented Eawag course on the topic of “Systematic Behaviour Change in Development Projects”. The applied course will take place on March 5 – 6, 2015, at Eawag Dübendorf.

The course will enable participants to plan, design, and evaluate evidence-based behaviour change campaigns. The participants will learn how to conduct a quantitative survey of behavioural determinants, how to identify the required behaviour change techniques and how to prove the effects and effectiveness of these techniques.

A live presentation of Dr. Kamal Kar about the CLTS<cltsfoundation.org/> approach and a Q&A session will be an integrated part of the course.

https://sanitationupdates.wordpress.com/2015/01/22/mar-2015-eawag-course-on-systematic-behaviour-change-in-development-projects/feed/3envhealth@usaideawagAll we want are toilets inside our homes!https://sanitationupdates.wordpress.com/2015/01/21/all-we-want-are-toilets-inside-our-homes/
https://sanitationupdates.wordpress.com/2015/01/21/all-we-want-are-toilets-inside-our-homes/#commentsWed, 21 Jan 2015 17:23:48 +0000http://sanitationupdates.wordpress.com/?p=10821Continue reading →]]>This article can be downloaded/viewed free of charge for the next 10 days

“All we want are toilets inside our homes!” The critical role of sanitation in the lives of urban poor adolescent girls inBengaluru, India. Environment and Urbanization, April 2015. by Anupama Nallari.

This paper describes how lack of access to adequate sanitation facilities affects the lives of adolescent girls in urban poor India. It draws specifically on the experiences of four adolescent girls, each living in one of four settlements in Bengaluru, India, and conversations with a larger group of girls.

Findings reveal that where sanitation facilities are sorely lacking, adolescent girls face many deprivations (education, free time, privacy and independent mobility) and risks (sexual harassment and assault, health risks, etc.), and that this inadequacy can be a structural pathway for cyclical gender-based disempowerment and injustice.

On 20 January, BRAC received the “Hall of Fame Award” for significant contributions to the sanitation sector in Bangladesh. The award was handed to Dr. Akramul Islam at the 14th World Toilet Summit 2015 in Delhi by Dr. Subramanian Swamy MP, Former Minister of India, and Jack Sim Founder of the World Toilet Organization in the presence of Minister Devendra Chaudhry, Special Secretary, Ministry of Power India.

Bangladesh has made remarkable progress in providing basic sanitation services to its people. It is now estimated that throughout Bangladesh, 57% use sanitary latrines, while a mere 3% of the people still practise open defecation.

Over 8 years, the BRAC WASH programme reached more than 66 million people, about half of the rural population of Bangladesh. It has successfully worked to improve household sanitation by creating demand for hygienic latrines while supporting an extensive supply chain and local businesses. Current coverage with hygienic and adequately maintained toilets is 82% in the 152 districts where BRAC has worked. All these successes have been underpinned by a strong provision of service to the poor and ultra-poor and by a unique hygiene promotion programme focusing on universal use and sustainability of services in communities, households and schools.

Filed under: Campaigns and Events, South Asia Tagged: BRAC, BRAC WASH II programme, World Toilet Organization, World Toilet Summit, World Toilet Summit 2015]]>https://sanitationupdates.wordpress.com/2015/01/21/brac-enters-sanitation-hall-of-fame/feed/0dietvorstWTO presents sanitation Hall of Fame Award to BRACCampaigning for better WASH in health care facilitieshttps://sanitationupdates.wordpress.com/2015/01/20/campaigning-for-better-wash-in-health-care-facilities/
https://sanitationupdates.wordpress.com/2015/01/20/campaigning-for-better-wash-in-health-care-facilities/#commentsTue, 20 Jan 2015 16:36:51 +0000http://sanitationupdates.wordpress.com/?p=10815Continue reading →]]>WHO is launching a global plan of action to improve access to WASH at all health care facilities. This kind of intersectoral collaboration is set to become a major theme in the post-2015 development agenda.

Better access to water, sanitation and hygiene (WASH) in health care facilities is crucial for mothers and babies to stay healthy. It is just as important as curative measures says Dr Maria Neira, the Director of Public Health and Environment at the World Health Organization (WHO) [1]. She announced that WHO will launch a global plan of action by March 2015 on improving access to WASH at all health care facilities [2].

In December 2014, a group of academics and representatives from WASH and maternal and newborn health (MNH) agencies, including WHO, presented a call to action for intersectoral collaboration [3]. They backed up their call with recent SHARE-funded research, which found that less than a third of births in Tanzania take place in a setting with safe water and sanitation [4]. Forthcoming WHO research surveyed health care facilities in 54 low-income countries and found that 38 percent did not have an improved water source, while 50 percent lacked improved sanitation [2].

Back in 2012, Simavi commissioned IRC to carry out a review of how access to safe water, sanitation and application of hygiene practices can affect maternal health [5]. The review concluded that “some very basic elements of human development related to water, sanitation and hygiene that were accepted in the 19th and early 20th centuries are still unavailable to a large proportion of pregnant women in the 21st century”.

Embedding WASH in other sectors will increase the health, social and economic benefits of the proposed Sustainable Development Goals (SDGs). An international group of WASH NGOs, led by Simavi and IRC, launched a call in December 2014 to incorporate WASH targets for schools, health centres and the workplace in the post-2015 development agenda.[6].

This all contributes to the growing realisation that “access to WASH facilities at home is simply not enough to achieve complete behavioural change and sustainable impact” [7]. Intersectoral collaboration is set to become a major theme for the global development sector in the future.

According to some media the Indian government has unleashed “toilet police” or “toilet gestapo” into the country [1]. In fact, the central government has instructed local officials to take photographs of new toilets to prove that they have not only been constructed but are also being used. If states don’t upload photos by February 2015, the water and sanitation ministry has threatened to withhold funding from a new national sanitation programme [2].

Open defecation free by 2019

Prime Minister Narendra Modi launched the Swachh Bharat (Clean India) Mission on 2 October 2014. His aim is to attain a 100 per cent open defecation free India by 2019. Since the launch over half a million household toilets have been constructed [3].

Photo: Swachh Bharat Mission

By implementing “real time monitoring” the government hopes it can correct past mistakes caused by ineffective monitoring and wasted investment in sanitation. The 2011 census revealed that 43% of government funded toilets were either “missing” or non-functional.[3]. Now the government wants to show that its investments in sanitation are delivering lasting results.

The Ministry of Drinking Water and Sanitation is appointing around 2 dozen additional staff including two Joint Secretaries and 4 Directors to strengthen the implementation and monitoring of the Swachh Bharat Mission. An Expert Committee for innovative sanitation technologies and a national telephone helpline for rural water supply and sanitation are other new initiatives that will support the Mission [5].

Smile please!

Local officials charged with monitoring toilet construction and use need to download an app on a mobile device. The app allows them to upload photos as well as the personal data and geo-coordinates of the beneficiaries to a public website. Progress is slow though: as of 14 January 2015, data of less than half a percent (2,383) of the newly constructed toilets has been recorded. Data collected before 2015 does not include toilet use.

How do other countries carry out large-scale monitoring?

Compared to examples of large-scale sanitation monitoring in Bangladesh and Indonesia, the toilet use indicators collected in India – is the toilet in use, is it clean and is water available – are rather limited.

The BRAC WASH programme in Bangladesh uses benchmark indicators developed by IRC for questions like: do all household members use toilets, do they use them at all times, and are there provisions for handwashing and pit emptying [6].

In Indonesia IRC has helped design a monitoring system for the SHAW (Sanitation, Hygiene and Water) programme, where every three months 20,000 community volunteers visit more than 300,000 households. For SHAW monitoring is not merely an accountability tool as it is in India, but a way to motivate and encourage people to improve their sanitation facilities and hygiene behaviour [7].

India’s decision to track toilet use as part of its new monitoring initiative is a major step forward. From its neighbours India can draw valuable lessons on how to monitor sanitation as a sustainable service that benefits all. .

BRAC plans to expand its scope beyond WASH to water security and from rural to urban areas, as well as moving from service provider to facilitator.

The BRAC WASH Programme is rebranding. For 2016-2020 it will be renamed as the BRAC Environmental WASH Programme. This reflects the planned gradual expansion in scope beyond WASH towards water security and from rural areas towards low income small towns, urban areas and coastal areas. Specific areas of intervention include solid waste management at scale, faecal sludge management, water security and quality, enhanced secondary school programmes and alternative sanitation technologies at scale.

There will be a gradual shift in operating styles from direct service to facilitation, advocacy and joint implementation, learning and monitoring the impact of programmes. Operational partners will include Government at all levels, civil society, the private sector and other NGOs already operating in the same regions. Planning and budgeting will need to be flexible and adapted to specific regional needs, requiring on-going investment in staff and partners capacities.

The strategy builds on ten years of experience in large-scale rural WASH programming. Ongoing support to the rural population will continue and be enhanced, for example, dealing with the well-known challenge of sanitation in difficult hydrogeological settings, and will be integrated into other local BRAC programmes. Staffing will be reduced where earlier programmes have achieved their objectives and appear sustainable within existing institutional structures.

In terms of its financing, a mix is envisaged of grants, joint implementation of programmes with government and multi-lateral institutions and business models that apply market solutions to large scale change. Cost sharing and user payment in some activities will remain a feature of the programme. Direct BRAC support is being applied to programme development and piloting, for example, alternative water services in the coastal region.

A study undertaken in Bangladesh revealed an 11 per cent increase in girls’ enrolment mainly due to the provision of sanitary toilets.” -Technical paper series/IRC

In Bangladesh the standard number of toilets in schools has been set as a minimum of one toilet for every 60 students. However, this is far from being achieved. The infographic below shows that on average, schools in Bangladesh have half the number of toilets required. However, although 94 per cent of schools have latrines within the compound, a large number remain unusable because they are dirty or broken.

Recently, the Bangladesh government has begun addressing the issues of water and sanitation more actively. A recent round table discussion on School sanitation: reality and required action focused on a range of issues, from the number of functional toilets in schools to the lack of menstrual hygiene facilities.

BRAC has been running its water, sanitation and hygiene (WASH) programme in schools in rural settings since 2007. The programme has supported over 5,000 schools since, installing separate latrines for girls, including facilities for menstrual hygiene management and hygiene training.

Photo: BRAC WASH programme

Boali High School in Kaliganj sub-district is one of the schools where the programme is operating. Mahbuba Begum, head teacher of the school, said she was concerned with the unhygienic latrines. All students and teachers had to use the same toilets. The school also grappled with low student enrolment and high dropout rates.

In 2010, when BRAC WASH approached the school, Mahbuba convinced school authorities to build more toilets for girls. The deal was to include menstrual hygiene facilities like sanitary napkin supplies, napkin disposal bins and a pit for disposal of bin contents.

The lack of separate latrines for girls and menstrual hygiene facilities in secondary schools are major factors in disproportionate rate of absence and dropout of adolescent girls.

Photo: BRAC WASH programme

Today the school has a student brigade maintaining WASH services. Hygiene lessons are integrated into the class routine. Most importantly, BRAC has found that many girls are more comfortable with buying napkins from the school rather than at the market. Supplied by the health workers at a lower price, girls are now more likely to buy sanitary napkins from the school. As a result, girls’ attendance has seen significant improvement. Improvements are also apparent in many other schools where WASH services have been made available.

The qualitative information system monitoring implemented by BRAC’s WASH programme shows that the use and cleanliness of facilities provided in secondary schools remain high.

Having started off as a means to address low attendance and high dropout rates for girls at schools, the programme has evolved to address the next series of threats towards improving education in Bangladesh. Careful assessment revealed that a safe water supply and sanitation facilities for boys is also essential to attain best results.

To address these needs, BRAC has recently started collaborating with Charity:Water. Water collection points, handwashing stations and separate toilets for boys are being installed in schools to meet the national standards.

For sustainable health impact, access to proper facilities and hygiene knowledge are essential. BRAC believes targeting school-going children is an effective way to spark change within communities.

Over 500 delegates are in Hanoi today at the start of FSM3: the 3rd International Faecal Sludge Management Conference. With a focus on FSM technology, FSM as a business and scaling up FSM in cities, the conference builds on the 2 previous editions both held in Durban, South Africa in 2012 and 2011.

Measurement of handwashing behavior: Based on a review of numerous studies using structured observation to measure behavior, hands are washed with soap after approximately 19 percent of events that involved using the toilet or coming into contact with a child’s excreta.1

Behavior change communication: The much-awaited results from the Super-Amma campaign, a handwashing behavior change intervention based on emotional drivers such as nurture and disgust, have started to come in. These results show that this approach to handwashing promotion has lasting impact and is achieving the diffusion of handwashing as a social norm.2,3 The campaign provides further confirmation that the knowledge of handwashing benefits is linked to its practice4,5 and that women’s participatory groups6 and handwashing education in schools,7 including students’ involvement in hygiene and sanitation clubs,9 are good settings in which to build that knowledge into action. Furthermore, the mere act of checking whether households have soap seems to increase their handwashing behavior.10

Handwashing hardware: The studies reviewed provide further evidence that the availability of appropriate handwashing stations and soap in schools,7 healthcare centers,8 and in the home12,13 increases handwashing prevalence, as does having piped water and functioning sewage mechanisms.14 Research provided further evidence that soap and ash are equally effective at cleaning hands,15 and that 4g of moringa oleifera leaf powder shows promise as an effective alternative to soap or ash for handwashing.16

Benefits of handwashing: A review estimated that handwashing with soap reduces the risk of diarrhea by 40 percent.1 Excluding the studies that could theoretically have been biased (or unblinded)—researchers knowing which people were exposed to handwashing interventions and which were not— handwashing with soap was estimated to reduce the risk of developing diarrhea by 23 percent.1 Further evidence showed that having soap in the home reduces children’s episodes of diarrhea, acute respiratory infections, eye infections, helminth infections, and school absences.18,19,20,21 It was found that good handwashing interventions in school also reduce school absences (but only for girls in one study)7 and that school-based interventions reduce episodes of diarrhea in preschool-aged siblings.17

Contamination: Various studies measured hands contaminated with rhinovirus,22 E coli,5, 25and helminth eggs.23 One study inversely correlated prevalence of handwashing with the amount of influenza virus found on household surfaces.24 A final study showed that in the rural areas hands revert to baseline levels of contamination within one hour after handwashing with soap.26

WASHplus Weeklies highlight topics such as Urban WASH, Household Air Pollution, Innovation, Household Water Treatment and Storage, Hand Washing, Integration, and more. If you would like to feature your organization’s materials in upcoming issues, please send them to Dan Campbell, WASHplus Knowledge Resources Specialist, at dacampbell@fhi360.org.

Billions of people lack access to a decent toilet. Attempts to address this gap through direct-subsidy models have often been proven unsustainable as, given resource limitations, they are unable to provide desirable toilets that families are likely to use and maintain over time. Based on private sector success in low-income markets, business-based approaches may be able to help bridge this gap through sustainable market-based mechanisms and associated incentives to meet the needs and desires of lower-income households.

Water For People is piloting sanitation business approaches and seeks to discover under what conditions these approaches are successful. Public sector influence is one condition that has the potential to facilitate or hinder private sector sanitation endeavors. This study aims to understand: (1) how the public sector enabling environment can facilitate or hinder low-cost sanitation enterprises; and (2) how NGOs can effectively engage the public sector to support sanitation businesses. Data were collected from Water For People staff and partners in nine countries and summary case studies were coded to discover prevailing themes.

Author: Gordon McGranahan, International Institute for Environment and Development (IIED), London, UK.

There are serious institutional challenges associated with low-cost sanitation in deprived urban communities. These include a collective action challenge, a coproduction challenge, a challenge of affordability versus acceptability, and a challenge related to housing tenure.

This paper examines these challenges, revealing both the importance of community-driven sanitation improvement and its difficulties. The nature of the challenges, and the means by which two successful community-driven initiatives have overcome them, suggest that while recognizing the human right to sanitation is important this should not be taken to imply that typical rights-based approaches are the appropriate means of realizing this right.

An excerpt – I watched the piles of feces go up the conveyer belt and drop into a large bin. They made their way through the machine, getting boiled and treated. A few minutes later I took a long taste of the end result: a glass of delicious drinking water.

The occasion was a tour of a facility that burns human waste and produces water and electricity (plus a little ash). I have visited lots of similar sites, like power plants and paper mills, so when I heard about this one—it’s part of the Gates Foundation’s effort to improve sanitation in poor countries—I was eager to check it out.

Why would anyone want to turn waste into drinking water and electricity?

Because a shocking number of people, at least 2 billion, use latrines that aren’t properly drained. Others simply defecate out in the open. The waste contaminates drinking water for millions of people, with horrific consequences: Diseases caused by poor sanitation kill some 700,000 children every year, and they prevent many more from fully developing mentally and physically.

If we can develop safe, affordable ways to get rid of human waste, we can prevent many of those deaths and help more children grow up healthy.

Western toilets aren’t the answer, because they require a massive infrastructure of sewer lines and treatment plants that just isn’t feasible in many poor countries. So a few years ago our foundation put out a call for new solution.

Another idea—and the goal of the project I toured—is to reinvent the sewage treatment plant. The project is called the Omniprocessor, and it was designed and built by Janicki Bioenergy, an engineering firm based north of Seattle. I recently went to Janicki’s headquarters to check out an Omniprocessor before the start of a pilot project in Senegal.

The Omniprocessor is a safe repository for human waste. Today, in many places without modern sewage systems, truckers take the waste from latrines and dump it into the nearest river or the ocean—or at a treatment facility that doesn’t actually treat the sewage. Either way, it often ends up in the water supply. If they took it to the Omniprocessor instead, it would be burned safely. The machine runs at such a high temperature (1000 degrees Celsius) that there’s no nasty smell; in fact it meets all the emissions standards set by the U.S. government.

Before we even started the tour, I had a question: Don’t modern sewage plants already incinerate waste? I learned that some just turn the waste into solids that are stored in the desert. Others burn it using diesel or some other fuel that they buy. That means they use a lot of energy, which makes them impractical in most poor countries.

The Omniprocessor solves that problem. Through the ingenious use of a steam engine, it produces more than enough energy to burn the next batch of waste. In other words, it powers itself, with electricity to spare. The next-generation processor, more advanced than the one I saw, will handle waste from 100,000 people, producing up to 86,000 liters of potable water a day and a net 250 kw of electricity.

If we get it right, it will be a good example of how philanthropy can provide seed money that draws bright people to work on big problems, eventually creating a self-supporting industry. Our foundation is funding Janicki to do the development. It’s really amazing to see how they’ve embraced the work; founder Peter Janicki and his family have traveled to Africa and India multiple times so they can see the scope of the problem. Our goal is to make the processors cheap enough that entrepreneurs in low- and middle-income countries will want to invest in them and then start profitable waste-treatment businesses.

We still have a lot to learn before we get to that point. The next step is the pilot project; later this year, Janicki will set up an Omniprocessor in Dakar, Senegal, where they’ll study everything from how you connect with the local community (the team is already working with leaders there) to how you pick the most convenient location. They will also test one of the coolest things I saw on my tour: a system of sensors and webcams that will let Janicki’s engineers control the processor remotely and communicate with the team in Dakar so they can diagnose any problems that come up.

The history of philanthropy is littered with well-intentioned inventions that never deliver on their promise. Hopefully, these early steps will help us make sure the Omniprocessor doesn’t join the list. If things go well in Senegal, we’ll start looking for partners in the developing world. For example I think it could be a great fit in India, where there are lots of entrepreneurs who could own and operate the processors, as well as companies with the skill to manufacture many of the parts.

It might be many years before the processor is being used widely. But I was really impressed with Janicki’s engineering. And I’m excited about the business model. The processor wouldn’t just keep human waste out of the drinking water; it would turn waste into a commodity with real value in the marketplace. It’s the ultimate example of that old expression: one man’s trash is another man’s treasure.

Filed under: Progress on Sanitation, Research Tagged: Bill & Melinda Gates Foundation]]>https://sanitationupdates.wordpress.com/2015/01/08/bill-gates-this-ingenious-machine-turns-feces-into-drinking-water/feed/0envhealth@usaidCLTS and Sustainability: A Work/Writeshop – Call for abstractshttps://sanitationupdates.wordpress.com/2015/01/07/clts-and-sustainability-a-workwriteshop-call-for-abstracts/
https://sanitationupdates.wordpress.com/2015/01/07/clts-and-sustainability-a-workwriteshop-call-for-abstracts/#commentsWed, 07 Jan 2015 13:19:09 +0000http://sanitationupdates.wordpress.com/?p=10783Continue reading →]]>The CLTS Knowledge Hub at the Institute of Development Studies (IDS) is hosting an international work- and writeshop on CLTS and Sustainability from 6-12 April 2015 at Lukenya Getaway near Nairobi, Kenya.

Potential contributors are requested to send an abstract of 500-900 words toP.Bongartz@ids.ac.ukby 31st January 2015. If your application is successful, you will be invited to work on a first draft to be submitted by 13th March 2015.

Unilever is also pioneering an innovative approach to the provision of sanitation, through its continued partnership with the World Toilet Organization, to launch the world’s first Domestos Toilet Academy in Vietnam. This academy will provide the business skills and training necessary for local entrepreneurs to source and supply latrines to their local communities – providing jobs and a boost to the economy, and at the same time promoting the importance of safe and hygienic sanitation. The Toilet Academy programme aims to be a sustainable and long-term solution to sanitation that benefits local society and helps stimulate local economy.

For 2.5 billion people across the developing world, having no access to even the most basic sanitation is a reality faced every day Photograph: Ahmed Jallanzo/EPA

Dr Nguyen Thi Kim Tien, Minister of Health Vietnam said: “Currently, many countries, including Vietnam, are still facing lots of difficulties and challenges. Challenges of globalization as well as environmental pollution, population growth and urbanization have impacted the sanitation crisis. In Vietnam, the Government has put strong emphasis on stimulating and promoting the “Patriotic Hygiene Movement” to mobilize all management agencies, organizations at all levels and entire nation to join hands in improving hygiene and sanitation as this is essential in the current context.”

“The active participation of businesses like Unilever, helping improve health and hygiene for communities is greatly appreciated and widely acknowledged. The launch of the Toilet Academy clearly demonstrates Unilever’s enormous effort and will positively contribute to improve sanitary conditions for Vietnamese people.”

Filed under: Uncategorized]]>https://sanitationupdates.wordpress.com/2014/12/31/unilever-to-launch-worlds-first-toilet-academy-in-vietnam/feed/0envhealth@usaid For 2.5 billion people across the developing world, having no access to even the most basic sanitation is a reality faced every day Photograph: Ahmed Jallanzo/EPA